Subscribe to RSS
Download PDF
DOI: 10.1055/s-0039-1684129
A0022 Effect of Remote Ischemic Preconditioning on Cerebral Vasospasm and Biomarkers of Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage
Publication History
Publication Date:
12 March 2019 (online)
Background: Cerebral vasospasm is a dreaded complication of aneurysmal subarachnoid hemorrhage (aSAH) predisposing one to delayed cerebral ischemia. We investigated the cerebroprotective effects of remote ischemic preconditioning (RIPC) in patients with aSAH.
Materials and Methods: This was a single-center, prospective, parallel-group, randomized, pilot trial, approved by institutional ethics committee. Patients with aSAH admitted to National Institute of Mental Health and Neurosciences for surgical clipping, fulfilling the trial inclusion criteria, were randomized to true RIPC (n = 12) (inflating upper extremity blood pressure cuff thrice for 5 minutes to 30 mm Hg above systolic blood pressure) or sham RIPC (n = 12) (inflating blood pressure cuff thrice for 5 minutes to 30 mm Hg) in a 1:1 allocation ratio using a computerized allocation sequence and block randomization. Our outcome measures, assessed by an observer blinded to the study intervention, were vasospasm on cerebral angiography and transcranial Doppler (TCD) study, and serum concentration of biomarkers of astrocytic and neuronal damage S100B and NSE at 24 hours after RIPC and on day 7 of ictus.
Results: Incidence of vasospasm on angiography (n = 13) was 25% (1/4 patients) in RIPC group and 89% (8/9 patients) in sham group (p = 0.052). Vasospasm on TCD study was diagnosed in 1/13 patients (7.7%) and 4/12 patients (33.3%) in true and sham RIPC groups, respectively (p = 0.16). There was no difference in serum concentrations of S100B and NSE between groups (p = 0.56 and 0.31, respectively) and over time in either groups (p = 0.318 and 0.494 for S100B and p = 0.661 and 0.174 for NSE in RIPC and sham groups, respectively). None had adverse effects on transient limb ischemia with RIPC.
Conclusions: This pilot trial showed that RIPC is feasible and safe. Our preliminary findings suggest a protective role of RIPC in prevention of vasospasm after aSAH, which needs confirmation by a larger trial.